tbuckley/cabot-search huggingface dataset:
Abstract 57: Distinct Gestational Blood Pressure Trajectories Predict Pregnancy, Birth, and Postpartum Health in a Low-Income Hispanic Population
Authors: Zhongzheng J Niu, Tingyu Yang, Fangqi Guo, Brendan Grubbs, Sandrah P Eckel, Claudia M Toledo-Corral, Jill Johnston, Genevieve F Dunton, Deborah Lerner, Nathana Lurvey, Laila Al-Marayati, Rima Habre, Theresa Bastain, Carrie V Breton, Shohreh Farzan
Journal: Circulation (2023)

Objective: Blood pressure (BP) typically drops to a nadir around 20 to 24 gestation weeks in a normal pregnancy. Distinct BP trajectories over pregnancy could reveal underlying cardiovascular function and predict future cardiovascular risk, but little is known about BP trajectories in Hispanic women. We aim to identify BP trajectories during pregnancy among low-income, Hispanic women. Methods: In the prospective Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) pregnancy cohort, we abstracted clinic BP measures of 732 participants who had an average of 12 BP measures over pregnancy, ranging from 4 to 41 weeks. We used latent class mixture modeling to identify BP trajectories. We examined associations of population characteristics, pregnancy and birth outcomes, and 1-year postpartum BP with the identified trajectories. Results: We identified three distinct BP trajectories ( Figure ). Compared to the majority (class 1, n=569), the consistently high class 2 (14.8%, 108) was characterized by a higher pre-pregnancy BMI (ppBMI, 32.3±7.6 vs. 27.6 ±6.1 Kg/m 2 ) and a higher proportion of having college or above education (21.3% vs. 14.9%), while the high-low-high U-shape class 3 (7.5%, 55) had a higher ppBMI (32.0±7.9 Kg/m 2 ) but lower proportion of having college or above education (9.1%). Risk of preeclampsia was the highest in class 3 (43.6%), followed by class 2 (10.2%) and class 1 (6.0%), while the risk of gestational diabetes was the highest in class 2 (14.8%), followed by class 1 (7.9%) and class 3 (7.3%). Birthweight and gestational duration were both significantly lower in class 3 than classes 1 and 2. One-year postpartum systolic BP was significantly higher in class 2 (120.2±16.0 mmHg) and class 3 (122.4±16.0 mmHg) than class 1 (111.7±26.2 mmHg) after adjusting for maternal age, pre-pregnancy BMI, parity, and education. Conclusion: Elevated blood pressure may develop into district trajectories in pregnancy that further predict pregnancy and birth outcomes, as well as postpartum blood pressure.
Abstract P107: Utilization of Statins in Patients With versus Without Cancer and Atherosclerotic Cardiovascular Disease
Authors: Izza Shahid, Jorge Carrasco Avila, Rakesh Gullapelli, Eleonora Avenatti, Roshni Mandania, Nihan Farooq, Aayush Shah, Sherif F Nagueh, Maan Malahfji, Jenny Chang, Khurram Nasir
Journal: Circulation (2023)

Background: Patients with cancer and concomitant atherosclerotic cardiovascular disease (ASCVD) have an increased risk of cardiovascular mortality compared with general population. Accordingly, optimal utilization of statins remains crucial to curtail adverse cardiovascular events in this high-risk cohort. We sought to compare the demographic burden and utilization of statins in ASCVD patients with cancer versus without cancer. Methods: Houston Methodist Learning Health System Outpatient Registry is an EMR-linked registry which was queried for adult patients with established ASCVD (2016-2022). International Classification of Diseases 10 th Revision Clinical Modification codes (ICD 10-CM) were utilized to ascertain ASCVD and cancer diagnosis. ATC codes were used to identify statin use and dose in the database, and this information was recorded based on medication reconciliation reviews with patients during every clinical encounter. Results: A total of 97,819 patients with ASCVD were included in this analysis of which 16,926 patients (17.3%) had a concurrent cancer diagnosis. Patients with ASCVD and cancer reported lower utilization of any statin (69.6% vs 71.2%) and high-intensity statin (33.2% vs 37.6%) compared with patients without cancer. Consistent results were observed across gender, age and racial strata with the exception of Hispanics and NHB, where ASCVD patients with cancer reported increased utilization of any statin compared with patients without cancer. Interestingly, patients with ASCVD and cancer were more likely to have LDL&lt;70mg/dL compared with ASCVD patients without cancer (41.1% vs 36.2%) across gender, age and racial strata. Conclusion: Albeit higher risk of adverse cardiovascular events, utilization of statins, particularly high-intensity statins remains suboptimal in cancer patients with established ASCVD. Considering the underlying cardiovascular risk patients with cancer and concomitant ASCVD may derive the greatest benefit from intensive LDL-C lowering therapies.
Abstract P352: A Review of Trials Designed to Achieve Diabetes Remission With Lifestyle Intervention Alone: Implications for Sub-Saharan Africa
Authors: Jean de Dieu Gatete, M. Grace Duhuze Karera, Annemarie Wentzel, MC Sage Ishimwe, Ram Jagannathan, Margrethe Horlyck-Romanovsky, Anne E Sumner
Journal: Circulation (2023)

Introduction: As the prevalence of type 2 diabetes (T2D) in sub-Saharan Africa rises and pharmacological hypoglycemics are often unavailable or prohibitively expensive, the ability to induce T2D remission through medication-free lifestyle interventions (LSI) needs urgent assessment. Objective: This scoping review evaluated trials designed to induce T2D remission by LSI without hypoglycemic medications. Methods: Using a combination of controlled vocabulary terms and key words specific to each database, PubMed, Embase, Cochrane, and CINAHL databases were searched for trials designed induce diabetes remission through LSI alone and were published before September 16, 2021. Of the 928 identified, 63 duplicates were removed. After title and abstract review, 727 irrelevant articles were excluded. After full-text review 112 inappropriate articles were removed. The remaining 26 articles described 16 trials. So each trial would be represented by one article, the latest publication from each trial was included. Of the 16 trials, 7 trials were on newly-diagnosed, treatment-naïve T2D and 9 trials were on established T2D with LSI initiated after discontinuation of medications. Results: The 16 trials were published between 1984 and 2021. They were conducted in 10 different countries. None were conducted in Sub-Saharan Africa. Median number of participants was 180 and 20 for the newly-diagnosed and established T2D respectively. Median duration was 5 years for newly-diagnosed T2D and 5 months for established T2D. For newly-diagnosed T2D, LSI involved dietary counseling with or without calorie restriction (~1500 kcal/d) and exercise. For established T2D trial the main focus was dietary intervention most often divided into 3 phases; Phase 1: low-calorie meal replacement; Phase 2: food re-introduction; and Phase 3: weight maintenance. Median remission rate for the 16 trials was 55%. The consensus across trials was with or without exercise, T2D remission requires diet modification and weight loss. Predictors of remission were: higher BMI and lower A1C at enrollment, shorter T2D at enrolment, and a 10% loss of baseline weight. Nonglycemic benefits of LSI included improved blood pressure, renal function and lipid profile as well as enhanced quality of life. Conclusions: LSI without medications can induce remission in both newly-diagnosed and established T2D. In sub-Saharan Africa, LSI as the initial therapeutic option needs exploration.
Abstract P356: Does Out-Migration Contribute to Poorer Health in Rural Communities? An Investigation Using Mortality in the US
Authors: Rebecca E Jones-Antwi, Suzanne E Judd, Solveig Argeseanu Cunningham
Journal: Circulation (2023)

People living in poor rural communities, particularly in the South, live shorter and less healthy lives than those residing elsewhere in the United States. The basis of this very high rural burden of heart, lung, and blood disease, which does not spare any race, is unclear. We hypothesized that a potential contribution to this phenomenon is differential selection of healthy individuals to migrate out of rural communities. We examined how county-level migration patterns relate to county-level mortality with a specific focus on rural counties. We compiled nationally representative county-level data migration data from Internal Revenue Services for years 2011-2019 and mortality data from National Center for Health Statistics at the Centers for Disease Control and Prevention for years 2018-2019. We standardized characteristics to a mean=0 and standard deviation=1 and modeled county-level age-adjusted death rate in 2019 using 2-level hierarchical linear regression. Out- and in-migration in 2019 was not significantly associated with age-adjusted death rate in 2019 after adjustment for social, economic and population factors at the county-level. However, when stratified by 6 categories of urban/rural, greater out-migration in the smallest rural counties (non-core) was associated with higher age-adjusted death rate after adjustment for other county factors [Beta (95% CI); 7.2 (0.11,14.28)] (Table 1). When including lagged out-migration rates for years prior to 2019, previous out-migration was associated with age-adjusted death rate in the second smallest rural county categorization (micropolitan). These findings help to ascertain another component potentially contributing to differentially poorer health in rural communities. Future work at the conference will further evaluate decade trends in migration across the US by county.
Abstract P253: Neighborhood Socioeconomic Status and Psychosocial Health Among Asian Americans Adults in New York City
Authors: Suditi Shyamsunder, Dyuthy Ramachandran, Chaeyoung Kim, Jaiveer Singh, Shozen Dan, Latha Palaniappan, Malathi Srinivasan, Eugene Yang, Stella Yi, Tali Elfassy
Journal: Circulation (2023)

Introduction: Social determinants of health, including one’s neighborhood environment, are a fundamental cause of health inequities. Low neighborhood socioeconomic status (NSES) is associated with adverse psychosocial and physical health profiles, yet limited data exists among Asian Americans. Our study aim was to determine the association between NSES with depressive symptoms and psychological distress among Asian American adults in New York City (NYC). Methods: The NYC Community Health Survey (CHS) is a population based annual telephone survey used to track the health of NYC residents. It is conducted in five languages including Mandarin and Cantonese. Data are weighted to be representative of NYC as a whole. Our sample included data from 4,557 Asian American participants of the 2017-2020 CHS cycles who were geolinked to their respective neighborhoods, conceptualized as the community district (CD). From publically available CD profiles, we constructed a NSES factor score from four indicators: proportion of the CD unemployed, in poverty, with a high rent burden, and with less than a high school education. Psychosocial health was measured using the Kessler-6 (K6) for nonspecific psychological distress and the 8-item Patient Health Questionnaire (PHQ8) for depressive symptoms, with higher scores indicating worse psychosocial health. We used hierarchical linear models to determine the association between NSES tertile with outcomes stratified by Asian sub-group or region (Chinese, Indian subcontinent, or other Asian). Models were adjusted for individual level age, sex, income, and education. All analyses accounted for the complex survey design of the CHS. Results: Among NYC Asian American residents, 52.1% were women, 45% were age 25-44 years, 25% had less than a high school education, and 56% lived below 200% of the federal poverty level. Among Chinese residents of NYC, living in a neighborhood of low compared with high NSES, was associated with lower PH8 score (beta: -0.65, 95% CI: -1.10, -0.19). Among residents of NYC with heritage from the Indian subcontinent, living in a neighborhood of low compared with high NSES, was associated with a higher K6 score (beta: 1.27, 95% CI: 0.59, 1.95). Associations were not significant among other Asians or for other outcomes. Conclusion: Our results indicate a heterogeneous association between NSES with psychosocial health among Asian Americans of NYC, persisting beyond individual-level SES. Low NSES was associated with adverse psychosocial health among Asians from the Indian subcontinent but better psychosocial health among Chinese Americans. Further examination into potential sources of resilience such as social cohesion, for Chinese American residents residing in low resourced neighborhoods, is warranted.
Abstract P348: Association of Social Determinants of Health and Hypertension and Diabetes Among Middle Eastern Immigrants in the United States: Evidence From the 2010-2018 National Health Interview Survey
Authors: Abeer Alharthi, Oluwabunmi Ogungbe, Sabrina d Elias, Faith Metlock, Thomas Hinneh, Suratsawadee Kruahong, Cheryl R Dennison Himmelfarb, Yvonne Commodore-Mensah
Journal: Circulation (2023)

Introduction: Recent literature has documented a high prevalence of cardiovascular disease (CVD) risk factors among Middle Eastern (ME) population. Yet, literature is sparse regarding the association of social determinants of health (SDoH) and CVD risk factors among ME immigrants. The objective of this study was to examine the associations between SDoH and hypertension and diabetes among ME immigrants in the U.S. Methods: A cross-sectional analysis was conducted using data from the 2010-2018 National Health Interview Survey (NHIS). SDoH were defined as income, education, employment, and health insurance. Hypertension and diabetes diagnoses were self-reported. Generalized linear models using Poisson distribution were fitted to examine the associations between the SDoH and hypertension and diabetes, separately. Results: We included 3,271 ME immigrants, 45% female, with mean age 46 years, 85.3% were insured, 44% had at least a college education, and 21% lived below poverty level. Almost 3% had diabetes and 8% had hypertension. Participants with higher income had lower odds (Adjusted Odds Ratio(aOR): 0.35, 95% CI): 0.18-0.69), while those who had health insurance had higher odds (aOR: 5.77, 95% CI: 1.37–24.32) of diabetes diagnosis. There were no significant associations between SDoH and hypertension diagnosis. Conclusion: Our analysis yielded significant associations of SDoH and diabetes among ME immigrants. Future investigations should focus on addressing health inequities to establish SDoH-informed care targeting CVD risk factors.
Abstract P225: Physical Activity and Heart Failure Prognosis in Older Postmenopausal Women
Authors: Michael J LaMonte, Moafi-Madani Miremad, Steven Nguyen, Andrea Z Lacroix, Kathleen M Hovey, Mary B Roberts, Ahmed Soliman, Charles B Eaton
Journal: Circulation (2023)

Background: Accumulating evidence suggests that participating in physical activity (PA) following heart failure (HF) diagnosis is associated with better prognosis, including lower mortality risk. Few studies have focused on this relationship in postmenopausal women, in whom HF burden is high. Methods: The present study, conducted in the Women’s Health Initiative, included 2,181 postmenopausal women (mean age 68 years; 85% white, 10% black, 3% Hispanic at enrollment in 1993-1998) who were diagnosed postbaseline with incident hospitalized acute HF and had at least one self-reported PA assessment before and after (mean age 73 at latter assessment) HF diagnosis. Total recreational PA was summarized in metabolic equivalent (MET) hours per week. Women were followed for all-cause mortality from their post-HF PA assessment through March 2014. Cox regression with age as the time scale was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality associated with PA categories (before/after HF): Inactive (&lt;7.5 MET-hr/wk)/Inactive, n=1,048; Active (≥7.5 MET-hr/wk)/Inactive, n=407; Inactive/Active, n=212; Active/Active, n=514. Results: There were 1,047 (48%) deaths during a mean follow-up of 12 years. Crude mortality rates per 1,000 person-years [number of deaths] across the above PA groups were 42.4 [533], 42.1 [206], 36.9 [94], and 34.7 [214]. After adjusting for age (timescale), race and ethnicity, and WHI study component, HRs (95% CI) for mortality across the PA groups were 1.00 (referent), 0.94 (0.79, 1.10), 0.80 (0.64, 1.01), and 0.60 (0.51, 0.71). Further adjustment for baseline education, BMI, physical function, smoking, menopausal hormone use, history of diabetes, hypertension, myocardial infarction, stroke, coronary revascularization, atrial fibrillation, and incident myocardial infarction during follow-up prior to HF diagnosis attenuated these associations but did not eliminate statistical significance for the Active/Active group: 1.00 (referent), 1.04 (0.87, 1.24), 0.87 (0.69, 1.10), 0.74 (0.62, 0.89). A similar pattern of results was evident when cardiovascular mortality was the study outcome. Conclusions: Maintaining PA levels following hospitalization for acute HF was associated with lower all-cause mortality in older postmenopausal women, an understudied population in this regard. Among women whose PA following HF diagnosis was higher than their pre-HF PA level, there was a trend for lower mortality although this did not achieve statistical significance. Studies are needed to determine whether PA is associated with prognosis in HF subtypes, such as HF with preserved ejection which is a prevalent HF subtype in older women.
Abstract P229: The Associations Between Muscular Strengthening Activity, Physical Function, and All-Cause Mortality Among Older Adults With Cardiovascular Disease
Authors: William Boyer, Deepika Laddu, Jessica Gorzelitz, Robert Booker
Journal: Circulation (2023)

Background: CVD is the leading cause of mortality in the US. Strong evidence suggests that aerobic physical activity (PA) is associated with reducing the risk of mortality among those with CVD. However, the extent to which muscular strengthening activity (MSA), as well as measures of physical functioning (PF), is related to mortality risk reduction is unknown in those with CVD. Purpose: To examine the associations between MSA and PF with all-cause mortality among a representative sample of the US with CVD. Methods: Participants aged ≥50 years (n=5,531; mean age 64.3 years, 52% female) from the 1999-2006 NHANES with complete covariates and outcomes were included. A subset (n=2,094) had MEC-measured PF data (time to peak force in seconds [TPF]; peak force in newtons [PF-N]; time to complete a 20-foot walk in seconds [TCW]) available at baseline through 2002. MSA volume was dichotomized as meeting (≥2 days/week) vs not meeting current MSA guidelines (&lt;2 days/week). Multivariable Cox proportional hazards regression models estimated associations (HR) between (1) MSA categories, and (2) quartiles of PF [TPF, TCW, PN-F], with all-cause mortality in the overall sample, and then stratified by enrollment age (&lt;50-64 years and ≥65 years). Results: A total of 2,046 deaths from any cause were identified over the 69,386 person-years of follow-up. Null associations were observed between MSA categories with mortality in multivariable models. Age stratified models revealed lower risk of all-cause mortality in adults ≥65 years meeting MSA guidelines versus insufficient MSA (HR 0.85, 0.73-0.99); however this association was not observed in adults aged 50-64 (HR 1.17, 0.82-1.65). Dose-response reductions in all-cause mortality risk were found across all quartiles for TCW and PF-N but not for TPF. These findings were consistent in adults aged 50-64 years and ≥65 years. Conclusions: Results suggest that meeting MSA recommendations is particularly beneficial for lowering all-cause mortality risk among those ≥65 years. Further, higher levels of PF appear to be associated with lower all-cause mortality risk among adults, supporting the role of assessing PF a potential indicator of future mortality risk. These findings collectively underscore the importance of including MSA in exercise prescriptions for older adults with CVD.
Abstract P102: Sex Differences in Laboratory Values Prior to In-Hospital Cardiac Arrest
Authors: Mina Attin
Journal: Circulation (2023)

Introduction: In-hospital cardiac arrest (IHCA) is a major public health problem. Before the pandemic, around 292,000 cases were treated yearly in the United States. It is associated with a significant morbidity and mortality, &lt;25% survival rate to hospital discharge. The effectiveness of prediction methods and established therapies in preventing IHCA remains debatable. Limited sex difference studies for evaluating therapies have led to healthcare inequities, with women faring worse. Laboratory (lab) values that guide and evaluate the efficiency of therapies in hospitalized patients are not fully explored with respect to sex differences. Hypothesis: There is a statistically significant difference in the serum electrolytes, estimated glomerular filtration rate; uncorrected ionized calcium and lactate from arterial blood gas between females and males within 72 hours of IHCA. Methods: A retrospective study was conducted in a single academic medical center using electronic health records of adult patients (≥18 years old) with a history of cardiopulmonary diseases who experienced IHCA (n=98) in acute care or an intensive care unit (2014-2016). Only the first episode of IHCA was recorded during the period of hospitalization. Patients were excluded if the IHCA was due to trauma, terminal cancer, and human immunodeficiency virus infection or if patients were comatose. Lab values were analyzed with respect to hours and days prior to IHCA. Linear mixed effect models (p&lt;0.05) were used to examine the sex differences in lab values within 72 hours/3 days of IHCA and were adjusted by age and ejection fraction using the Tukey-Kramer procedure. Day 0= 0-23 hours, Day 1= 24-47 hours, and Day 2=48-72 hours. Results: The sample’s characteristics included: age (69±15), sex (female 33%,), location (intensive care units 54%), the initial rhythm of cardiac arrest (ventricular tachycardia, ventricular fibrillation 28%), ejection fraction (44±20), history of coronary artery diseases (78%,), pulmonary diseases (29%), unsuccessful return of spontaneous circulation (38%), and survival to hospital discharge (22%). Unadjusted statistical significance within 72 hours of IHCA was found in sodium and chloride (p&lt;0.0047, p&lt;0.001). Statistical significance was found when adjusted by age and ejection fraction in sodium, potassium, and chloride (p&lt;0.04, p&lt;0.001, p&lt;0.00). Significant statistical sex differences were found after adjusting for age and ejection fraction in potassium and lactate when comparing day 0 with day 1 and day 2 (p&lt;0.03, p&lt;0.001). Conclusions: Quantifying lab values concerning sex differences will tailor therapeutic therapies to biological differences and will guide the areas of improvements in patient outcomes.